Diagnosis of Acute intestinal obstruction - symptoms, signs, investigations

Here is an approach to diagnosis of acute intestinal obstruction in which, we are going to discuss the symptoms, signs and diagnostic investigations of I.O .

Clinical Picture Of Acute IO

Symptoms 
: Characterized by Pain, Vomiting & Absolute constipation.
Pain
1. suddenly severe colicky pain (in bouts)
2. more in Small IO > Large IO
3. starts allover the abdomen but mainly around the umbilicus
4. absent in paralytic ileus, in strangulation à ischemic stabbing
Vomiting
Onset
1.      High small IO à early with the onset of pain
2.      low small IO à  after few hours from the onset of pain
3.      colonic obstruction à delayed for 1-2 days.
Content à digested food àgastric juice à bile à Faeculant vomiting.
Absolute Constipation
-          No faeces or flatus is passed inspite of desire.
-          Blood may pass per rectum in intussusceptions or MVO
Signs
General
-          Dehydration.
-          Pulse:& Temp.: à Normal
-         B.P: (affected except in extensive strangulation)
Local
Inspection
1. Rigidity

-          Absent in simple occlusion.
-          may be present in strangulation
2. Distension of the abdomen
-          high small IO à may be absent.
-          low IO à mainly central (Step-Ladder pattern).
-          Colonic obstruction à mainly in the flanks except volvulus of pelvic colon à central.
3. Visible peristalsis.
4. Hernial orifices
5. Scars of previous operations
Palpation
1. Tenderness à in strangulation à tenderness & rebound tenderness.
2. Tumor Mass
-          in malignancy.
-          intussusception à sausage-shaped swelling.
-          volvulus of pelvic colonà tense tympanitic balloon.
Percussion à Tympanitic abdomen.
Auscultation
-          Intestinal sounds à frequent, loud (Mad abdomen).
-          In paralytic ileus à silent.
PR:
-          Carcinoma of the rectum
-          Impacted faeces in the rectum.
Investigations
Routine CB4 +
-          C.B.C à Hemoconcentration, leucocytosis.
-          KFT à Pre-renal failure, disturbed pH, Na, K, Cl
Diagnosis
Double Enema Test: à On admission & After ½ hr
Plain X-Ray Abdomen:
intestinal-obstruction

Erect à multiple fluid levels (sign of obstruction).
Supine
-          Jejunal loops à  fine transverse striations (concertina effect).
-          Ileal loops à cylindrical shadows.
-          Colon à haustral folds 

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